Delay in the diagnosis of cutaneous malignant melanoma: a prospective study in 250 patients

Article Abstract:

The prognosis of malignant melanoma is strongly dependent on its stage at the time of diagnosis. This skin cancer may be cured by simple surgery in its early stage. If the cancer has begun to invade the surrounding tissues, the prognosis is poor. If melanoma has spread to other places in the body, disease progression and death are inevitable. It is clear, therefore, that any delay in the recognition and treatment of early melanoma may have disastrous consequences for the patient. A study of 250 consecutive cases of melanoma was conducted to determine the extent that diagnosis and treatment of this disorder are subject to delays, both patient and professional. It was found that the average delay from the first observed physical change to treatment was 11.1 months. Almost 10 months of this interval was delay of the patient in seeking medical advice. However, no correlation could be found between the delay in diagnosis and the stage of the cancer when diagnosed. Most patients are unable to recognize the earliest signs of melanoma, and notice only such indications as bleeding and ulceration, which appear only later in the development of the cancer. A significant difference, however, was found between the melanomas which were diagnosed on the basis of symptoms and those which were discovered during routine skin surveillance. Routine skin surveillance or incidental discovery made during an examination revealed 71 cancers; these patients had smaller melanomas with a more favorable prognosis than the patients who discovered their melanomas on the basis of symptoms. These results indicate that greater emphasis should be placed on routine skin surveillance. Furthermore, the results suggest that patients should be encouraged to report any changes which might suggest melanoma prior to the development of ulcers or bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Evaluation of melanoma/skin cancer screening in Massachusetts: preliminary results

Article Abstract:

Since early diagnosis improves the prognosis for melanoma and other types of skin cancer, routine screening should lead to better patient survival. But few studies have been conducted to determine if this is indeed the case. The American Academy of Dermatology has sponsored free cancer screening clinics since 1985. In 1986 and 1987, a statewide screening program was undertaken in Massachusetts. To evaluate the effectiveness of the program, positive screenees were followed to their final diagnosis. A total of 2,560 people were screened in these two years. No further follow-up was deemed necessary for 1,773 people based on a normal examination at the time of screening. Of the 31 percent who had an abnormal exam, 459 persons, or 18 percent of the original group, were suspected to have cancerous or precancerous conditions and were referred for further evaluation. Follow-up information was available on 288. Twenty-two had melanoma, 12 had squamous cell carcinoma, and 144 had basal cell carcinoma. These figures compare with those obtained in other types of cancer screening programs, suggesting that a visual examination by a dermatologist is an effective tool for identifying possible cases of skin cancer. It remains to be determined whether these screening procedures translate into improved survival for the patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical screening, Health screening

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Do pediatricians counsel families about sun protection? A Massachusetts survey

Article Abstract:

Most pediatricians in Massachusetts appear to routinely recommend sun protection strategies to patients during summer months. Researchers surveyed 756 pediatricians to determine the degree they had incorporated sun-safety instructions into routine practice. Seventy percent of doctors recommended sunscreen use and other protective techniques to more than half their patients. Such physicians were more likely to be in private practice or working for health maintenance organizations, and more likely to regularly use sunscreens themselves.

Prevention, Practice, Study and teaching, Skin, Pediatricians, Radiation effects, Skin, Effect of radiation on the

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